Relatório de custos relacionados às próteses valvares e conjunto de circulação extracorpórea / Cost report related to valve prostheses and circulation set extracorporeal

ASSUNTO: Trata-se de relatório de custos de próteses valvares e conjunto de circulação extracorpórea realizado pelo Núcleo de Avaliação de Tecnologias (NATS INC), sob demanda da Direção Geral do Instituto Nacional de Cardiologia (INC) de modo a contribuir para a resolução do atual impasse sobre os valores de aquisição versus valores de ressarcimento dos procedimentos da Tabela de Procedimentos, Medicamentos, Órteses, Próteses e Materiais do SUS, por parte do Ministério da Saúde (Coordenação Geral de Atenção Especializada -CGAE/DAET/SAES). CONSIDERAÇÕES TÉCNICAS: Método empregado para avaliação dos custos dos matérias em comparação ao valor de ressarcimento da tabela SUS. RESULTADOS: próteses valvares e conjunto de circulação extracorpórea padronizados no INC (extraídos do sistema de gestão de estoques da unidade) com código CATMAT, data e quantidade da última compra (entrada), preço de aquisição, custo médio, código e repasse pelo SIGTAP. A prótese valvar aórtica de pericárdio bovino sem sutura (BR0437592) está em avaliação pela Comissão de Padronização de Material do INC, podendo ou não ser despadronizada. Vale destacar que estes são os códigos adotados no INC após a última revisão de padronização. A criação do código INC 58913 para prótese valvar mitral mecânica 18 a 23 mm teve por objetivo apenas separar as próteses para uso em pediatria, porém o custo unitário provavelmente será o mesmo da prótese descrita no código INC 58182. No caso da circulação extracorpórea, o INC adquiri o oxigenador adulto ­ circuito para circulação extracorpórea e em separado hemoconcentradores e bomba centrífuga, pois estes dois últimos não são utilizados em todos os procedimentos. No ano de 2020 as compras com maior variação de preço ocorreram na região Sudeste. Dos itens com código de repasse do SIGTAP, apenas 3: PRÓTESE VALVULAR MECÂNICA DE DUPLO FOLHETO (07.02.04.057-6); CONJUNTO PARA CIRCULAÇÃO EXTRACORPÓREA (PEDIÁTRICO) (07.02.04.021-5) e BOMBA CENTRÍFUGA DESCARTÁVEL PARA USO EM CIRCULAÇÃO EXTRACORPÓREA E/OU CIRCULAÇÃO ASSITIDA (07.02.05.001-6), apresentaram média de preço inferior ao repasse da tabela SUS. No ano de 2021 a região Sudeste também apresentou as maiores variações de preço. Apenas o CONJUNTO PARA CIRCULAÇÃO EXTRACORPÓREA (PEDIÁTRICO) (07.02.04.021-5), dos itens com código de repasse no SIGTAP, apresentou média de preço inferior ao repasse da tabela SUS. As próteses valvulares e o conjunto de circulação extracorpórea apresentaram variação expressiva de preço. No caso do conjunto de circulação extracorpórea, na região Sudeste o preço variou de -75% a mais de 2.000%. Em pesquisa no site da marca adquirida no valor de R$ 35.000,00, o fabricante relata que são oxigenadores para suporte cardiorrespiratório prolongado (14 dias), com redução no consumo de plaquetas e livre de heparina (adequado para pacientes com trombocitopenia Induzida por heparina aguda). Foram estimadas as médias ponderadas e médias (incluindo o custo do INC, para os matérias adquiridos no período avaliado) de custo unitário com e sem os outliers. Provavelmente estes valores extremamente divergentes se devem ao fato de que itens diferenciados são adquiridos utilizando o mesmo código do CATMAT. Foi realizada uma tentativa de identificação destes itens diferenciados no próprio site sem sucesso. Seria necessário o acesso aos editais de compras das unidades envolvidas, o que não foi possível neste momento (por este motivo os cálculos foram feitos com e sem os outliers). Com exceção dos hemoconcentradores, que não foi localizado código SIGTAP, todos os itens adquiridos nos anos de 2020 e 2021 pelo INC estão com preços abaixo do valor de repasse do SIGTAP.

Use of extracorporeal bypass is associated with improved outcomes in open thoracic and thoracoabdominal aortic aneurysm repair.

OBJECTIVE: There is no consensus on the use or benefit of extracorporeal circulation (EC) during aneurysm repair of the descending thoracic aorta (DTA) or thoracoabdominal aorta (TAA). We evaluated the role of EC during DTA or TAA aneurysm repair using U.S. Medicare data. METHODS: Medicare (2004-2007) patients undergoing open repair of nonruptured DTA or TAA aneurysm were identified by International Classification of Diseases, Ninth Revision code. Specific exclusions included ascending aortic or arch repairs, concomitant cardiac procedures, and procedures employing deep hypothermic circulatory arrest. The impact of EC (code 3961) on early and late outcomes was analyzed using univariate analysis and multivariable regression. Survival was assessed using Kaplan-Meier analysis and Cox proportional hazards regression models. RESULTS: There were 4230 patients who had repair of intact DTA or TAA aneurysms, 2433 (57%) of which employed EC. Differences in baseline clinical features of EC and non-EC patients showed that patients undergoing aortic reconstruction with EC were older (73 ± 1 years vs 72 ± 1 years; P = .002), were more likely to be female (53% vs 47%; P < .001), and had more hypertension (56% vs 53%; P = .02); they had less chronic obstructive pulmonary disease (28% vs 34%; P < .0001), peripheral vascular disease (5.7% vs 11.3%; P < .001), and chronic kidney disease (7.7% vs 5.5%; P = .003). The 30-day mortality (9.7% for EC vs 12.2%; P = .02) and any major complication (49% for EC vs 58%; P < .001) were significantly reduced with EC use. EC use was associated with a shorter length of stay (13.5 ± 13 days vs 17.2 ± 18 days; P < .01) and lower total hospital charges ($151,000 ± 140,000 vs $180,000 ± 190,000; P < .01) compared with non-EC patients. EC patients were more likely to be discharged home instead of to an extended care facility (67% vs 56%; P < .01). Multivariable regression modeling to adjust for baseline clinical differences showed EC to independently reduce the risk of operative mortality (odds ratio [OR], 0.80; 95% confidence interval [CI], 0.65-0.97; P = .02), any complication (OR, 0.67; 95% CI, 0.59-0.76; P < .01), pulmonary complications (OR, 0.68; 95% CI, 0.59-0.79; P < .01), and acute renal failure (OR, 0.52; 95% CI, 0.44-0.61; P < .01). Long-term survival was higher (log-rank, P < .01) in EC patients at 1 year (81% ± 0.8% vs 73% ± 1%) and 5 years (67% ± 1% vs 52% ± 1%). Risk-adjusted Cox proportional hazards regression also showed that EC was independently associated with improved long-term survival (hazard ratio, 0.69; 95% CI, 0.63-0.74; P < .01). CONCLUSIONS: Although important clinical variables such as DTA or TAA aneurysm extent and spinal cord ischemic complications cannot be assessed with the Medicare database, EC use during open DTA and TAA aneurysm repair is associated with improved late survival and a significant reduction in operative mortality, morbidity, and procedural costs. These data indicate that EC should be a more widely applied adjunct in open DTA or TAA aneurysm repair.

The use of extracorporeal carbon dioxide removal to avoid intubation in patients failing non-invasive ventilation--a cost analysis.

BACKGROUND: To evaluate the economic implications of the pre-emptive use of extracorporeal carbon dioxide removal (ECCO2R) to avoid invasive mechanical ventilation (IMV) in patients with hypercapnic ventilatory insufficiency failing non-invasive ventilation (NIV). METHODS: Retrospective ancillary cost analysis of data extracted from a recently published multicentre case-control-study (n = 42) on the use of arterio-venous ECCO2R to avoid IMV in patients with acute on chronic ventilatory failure. Cost calculations were based on average daily treatment costs for intensive care unit (ICU) and normal medical wards as well as on the specific costs of the ECCO2R system. RESULTS: In the group treated with ECCO2R IMV was avoided in 90 % of cases and mean hospital length of stay (LOS) was shorter than in the matched control group treated with IMV (23.0 vs. 42.0 days). The overall average hospital treatment costs did not differ between the two groups (41.134 vs. 39.366 €, p = 0.8). A subgroup analysis of patients with chronic obstructive pulmonary disease (COPD) revealed significantly lower median ICU length of stay (11.0 vs. 35.0 days), hospital length of stay (17.5 vs. 51.5 days) and treatment costs for the ECCO2R group (19.610 vs. 46.552 €, p = 0.01). CONCLUSIONS: Additional costs for the use of arterio-venous ECCO2R to avoid IMV in patients with acute-on-chronic ventilatory insufficiency failing NIV may be offset by a cost reducing effect of a shorter length of ICU and hospital stay.

Coronary artery bypass grafting with minimal versus conventional extracorporeal circulation; an economic analysis.

BACKGROUND: This study aims to develop a methodological framework for the comparative economic evaluation between Minimal Extracorporeal Circulation (MECC) versus conventional Extracorporeal Circulation (CECC) in patients undergoing coronary artery bypass grafting (CABG) in different healthcare systems. Moreover, we evaluate the cost-effectiveness ratio of alternative comparators in the healthcare setting of Greece, Germany, the Netherlands and Switzerland. METHODS: The effectiveness data utilized were derived from a recent meta-analysis which incorporated 24 randomized clinical trials. Total therapy cost per patient reflects all resources expensed in delivery of therapy and the management of any adverse events, including drugs, diagnostics tests, materials, devices, blood units, the utilization of operating theaters, intensive care units, and wards. Perioperative mortality was used as the primary health outcome to estimate life years gained in treatment arms. Bias-corrected uncertainty intervals were calculated using the percentile method of non-parametric Monte-Carlo simulation. RESULTS: The MECC circuit was more expensive than CECC, with a difference ranging from €180 to €600 depending on the country. However, in terms of total therapy cost per patient the comparison favored MECC in all countries. Specifically it was associated with a reduction of €635 in Greece, €297 in Germany, €1590 in the Netherlands and €375 in Switzerland. In terms of effectiveness, the total life-years gained were slightly higher in favor of MECC. CONCLUSIONS: Surgery with MECC may be dominant (lower cost and higher effectiveness) compared to CECC in coronary revascularization procedures and therefore it represents an attractive new option relative to conventional extracorporeal circulation for CABG.

Postoperative costs associated with outcomes after cardiac surgery with extracorporeal circulation: role of antithrombin levels.

OBJECTIVE: To study the impact on postoperative costs of a patient's antithrombin levels associated with outcomes after cardiac surgery with extracorporeal circulation. DESIGN: An analytic decision model was designed to estimate costs and clinical outcomes after cardiac surgery in a typical patient with low antithrombin levels (<63.7%) compared with a patient with normal antithrombin levels (≥63.7%). The data used in the model were obtained from a literature review and subsequently validated by a panel of experts in cardiothoracic anesthesiology. SETTING: Multi-institutional (14 Spanish hospitals). PARTICIPANTS: Consultant anesthesiologists. MEASUREMENTS AND MAIN RESULTS: A sensitivity analysis of extreme scenarios was carried out to assess the impact of the major variables in the model results. The average cost per patient was €18,772 for a typical patient with low antithrombin levels and €13,881 for a typical patient with normal antithrombin levels. The difference in cost was due mainly to the longer hospital stay of a patient with low antithrombin levels compared with a patient with normal levels (13 v 10 days, respectively, representing a €4,596 higher cost) rather than to costs related to the management of postoperative complications (€215, mostly owing to transfusions). Sensitivity analysis showed a high variability range of approximately ±55% of the base case cost between the minimum and maximum scenarios, with the hospital stay contributing more significantly to the variation. CONCLUSIONS: Based on this analytic decision model, there could be a marked increase in the postoperative costs of patients with low antithrombin activity levels at the end of cardiac surgery, mainly ascribed to a longer hospitalization.

[Evaluation of extracorporeal liver support systems in the treatment of liver failure. A systematic review]. / Evaluación de los sistemas de soporte hepático extracorpóreo en el tratamiento de la insuficiencia hepática. Revisión sistemática.

OBJECTIVE: To evaluate the safety and efficacy of the MARS and Prometheus extracorporeal liver support systems in the treatment of liver failure. DESIGN: We performed a systematic review of the literature from January 1999 to June 2009 in the Medline, Embase, HTA, DARE, NHSEED, Cochrane Library Plus, Clinical Trials Registry and HSRPROJ databases. Study selection was based on a series of previously established inclusion criteria related to the study design, population, type of intervention, language, and outcome measures. PATIENTS AND INTERVENTIONS: Patients with acute liver failure or acute exacerbations of chronic liver failure treated with the MARS or Prometheus systems. OUTCOME MEASURES: Data on safety, long-term survival, clinical effects and biochemical and hemodynamic variables. RESULTS: We selected 22 studies evaluating the safety and efficacy of the MARS and Prometheus systems. Adequate evaluation of these techniques was hampered by the heterogeneity of the studies and their methodological limitations. CONCLUSIONS: Extracorporeal liver support systems are able to purify both hydrosoluble and protein-bound substances. However, current data show that only the MARS system reduces mortality in acute liver failure and in acute exacerbations of chronic liver failure, although this reduction is non-significant. These techniques can be considered safe, with adverse effects similar to those of the control group. Their main indication is severe liver failure, for short periods while the liver recovers or a liver transplant becomes available.

[Fast track in cardiac surgery]. / Fast Track in der Herzchirurgie.

Fast track in cardiac surgery is not well defined. In the past early or immediate extubation was used as a marker. After cardiac surgery this parameter is not sufficient. In addition to cardiorespiratory stability, circulatory and haemostatic homeostasis are also required. Therefore the current Fast Track concept includes a period of intensive monitoring of the patient postoperatively to establish stability. Thereafter intensive care medicine should not be required. Evolving new surgical concepts in combination with appropriate anaesthesiologic management will lead to wide application of fast track cardiac surgery in the future.

Guidelines for indications for the use of extracorporeal life support in refractory cardiac arrest. French Ministry of Health.

Around 50,000 cardiac arrests (CA) occur each year in France and survival remains as low as 3 to 5%. Cardiopulmonary resuscitation (CPR) includes several treatment techniques for CA that are regularly updated in French, European, and international guidelines. Extracorporeal life support (ECLS) has been suggested as a therapeutic option in refractory CA since 1976. However, the use of this technique has remained limited to hypothermic CA and to CA occurring during the perioperative period of cardiothoracic surgery, mainly because the results of the initial trials were deceptive. The ease of use of more recent miniaturized ECLS devices has permitted a wider use of the technique in cardiac surgery departments and intensive care units (ICU). Encouraging results have been published recently by several teams in France and Taiwan, in single centre retrospective and prospective cohorts. In these studies, most CA were from toxic or cardiac causes and occurred in the hospital. In these highly selected cohorts, survival with good neurological outcome has been observed in up to 20 to 30% of cases. Nevertheless, the preliminary results of the use of ECLS in out-of-hospital CA in France are very poor, with less than 1% survival being observed. It should be emphasized that the time delay to commencing ECLS in out-of-hospital CA was far greater than that previously reported in in-hospital CA. These contrasting results lead physicians who perform CPR to question the indications and contra-indications of ECLS in these conditions and the French health authorities to question the value of such costly techniques (real cost as well as use of important and highly specialized human resources). The authors shared the following concerns that require emphasis: that an uncontrolled development of ECLS in out-of-hospital CA may lead to its abandonment because of very poor favourable outcome; that ECLS may lead to the survival of patients with poor neurological recovery and the associated considerable suffering for the patient and its relatives (although further evolution to brain death has been observed in most of these surviving patients with poor neurological outcome); that nonhomogeneous criteria may be applied in France for the use of ECLS in case of refractory CA because of the lack of any published data on its indications and contra-indications.Therefore, French medical scientific societies, under the auspices of the French Ministry of Health, selected a group of experts to propose guidelines that could help physicians performing CPR for refractory CA in deciding if ECLS should be used or not. The following text reflects a consensus obtained by these experts coming from different scientific and medical background at the present time. It should be noted that the views expressed are very likely to be modified in the near future because this topic is evolving rapidly.

Custos comparativos entre a revascularização miocárdica com e sem circulação extracorpórea / Comparative costs between myocardial revascularization with or without extracorporeal circulation

FUNDAMENTO: Técnicas cirúrgicas de revascularização miocárdica sem o uso de circulação extracorpórea (CEC) projetaram esperanças de resultados operatórios com menor dano sistêmico, menor ocorrência de complicações clínicas e menor tempo de internação hospitalar, gerando expectativas de menor custo hospitalar. OBJETIVO: Avaliar o custo hospitalar em pacientes submetidos à cirurgia de revascularização miocárdica com e sem o uso de CEC, e em portadores de doença multiarterial coronariana estável com função ventricular preservada. MÉTODOS: Os custos hospitalares foram baseados na remuneração governamental vigente. Acrescentaram-se aos custos uso de órteses e próteses, complicações e intercorrências clínicas. Consideraram-se o tempo e os custos de permanência na UTI e de internação hospitalar. RESULTADOS: Entre janeiro de 2002 e agosto de 2006, foram randomizados 131 pacientes para cirurgia com CEC (CCEC) e 128 pacientes sem CEC (SCEC). As características basais foram semelhantes para os dois grupos. Os custos das intercorrências cirúrgicas foram significativamente menores (p < 0,001) para pacientes do grupo SCEC comparados ao grupo CCEC (606,00 ± 525,00 vs. 945,90 ± 440,00), bem como os custos na UTI: 432,20 ± 391,70 vs. 717,70 ± 257,70, respectivamente. Os tempos de permanência na sala cirúrgica foram (4,9 ± 1,1 h vs. 3,9 ± 1,0 h), (p < 0,001) na UTI (48,2 ± 17,2 h vs. 29,2 ± 26,1h) (p < 0,001), com tempo de entubação (9,2 ± 4,5 h vs. 6,4 ± 5,1h) (p < 0,001) para pacientes do grupo com e sem CEC, respectivamente. CONCLUSÃO: Os resultados permitem concluir que a cirurgia de revascularização miocárdica, sem circulação extracorpórea, proporciona diminuição de custos operacionais e de tempo de permanência em cada setor relacionado ao tratamento cirúrgico.

BACKGROUND: Surgical techniques of myocardial revascularization without the use of extracorporeal circulation (ECC) have raised hopes of attaining operative results with less systemic damage, lower occurrence of clinical complications and shorter hospital stay duration, generating expectations of lower hospital costs. OBJECTIVE: To evaluate the hospital costs in patients submitted to myocardial revascularization with and without ECC and in those with stable multiarterial coronary disease with preserved ventricular function. METHODS: The hospital costs were based on the existing governmental reimbursement. The costs included that of ortheses and prostheses and clinical complications. The time and costs of ICU stay and hospital stay duration were considered. RESULTS: Between January 2002 and August 2006, 131 patients were randomized to surgery with ECC (SECC), whereas 128 were randomized to surgery without ECC (WECC). The basal characteristics were similar for both groups. The costs of surgical complications were significantly lower (p < 0.001) in patients from the WECC when compared to the SECC group (606.00 ± 525.00 vs. 945.90 ± 440.00), as well as ICU costs: 432.20 ± 391.70 vs. 717.70 ± 257.70, respectively. The duration of the operating room stay were 4.9 ± 1.1 h vs. 3.9 ± 1.0 h, p < 0.001; at the ICU it was 48.2 ± 17.2 h vs. 29.2 ± 26.1h) (p < 0.001), with intubation time of 9.2 ± 4.5 h vs. 6.4 ± 5.1h, p < 0.001 for patients from the group with and without ECC, respectively. CONCLUSION: The present study allowed us to conclude that the myocardial revascularization surgery without extracorporeal circulation results in the decrease of operational costs and duration of the stay in each section related to the surgical treatment.

A novel, low cost, disposable, pediatric pulsatile rotary ventricular pump for cardiac surgery that provides a physiological flow pattern.

Research is underway to develop a novel, low cost, disposable pediatric pulsatile rotary ventricular pump (PRVP) for cardiac surgery that provides a physiological flow pattern. This is believed to offer reduced morbidity and risk exposure within this population. The PRVP will have a durable design suitable for use in short- to mid-length prolonged support after surgery without changing pumps. The design is based on proprietary MC3 technology which provides variable pumping volume per stroke, thereby allowing the pump to respond to hemodynamic status changes of the patient. The novel pump design also possesses safety advantages that prevent retrograde flow, and maintain safe circuit pressures upon occlusion of the inlet and outlet tubing. The design is ideal for simple, safe and natural flow support. Computational methods have been developed that predict output for pump chambers of varying geometry. A scaled chamber and pump head (diameter = 4 in) were prototyped to demonstrate target performance for pediatrics (2 L/min at 100 rpm). A novel means of creating a pulsatile flow and pressure output at constant RPM was developed and demonstrated to create significant surplus hydraulic energy (>10%) in a simplified mock patient circuit.

Thoracic aortic aneurysm repair. Direct hospital cost and Diagnosis Related Group reimbursement.

OBJECTIVE: The main objective of this study was to analyze direct hospital cost and to compare cost with existing DRG reimbursement for open repair of thoracic and thoraco-abdominal aortic disease. STUDY SAMPLE AND METHODOLOGY: Between January 2003 and September 2003, the cost of treatment for 24 surgical procedures on ascending aorta and arch, descending or thoraco-abdominal aortic disease were examined prospectively. Seven patients had urgent or emergency surgeries. Ten had sternotomies for disease of the ascending aorta and aortic arch; two had left thoracotomies and three thoraco-laparotomy incisions with procedures performed on x-corporeal circulation. Nine other patients had more distal thoraco-abdominal aortic operations with a clamp-and-sew technique. Micro-cost analysis was performed on each hospital stay, in addition overhead hospital costs were allocated to each procedure. RESULTS: The patients were grouped by discharge diagnosis (ICD-10) and surgical procedure performed (NCSP) into Norwegian DRG code. Patient with surgery on ascending aorta & aortic arch were allocated to DRG 108 (n=9) or 483 (tracheostomy, n=1) while patient with surgery on descending or thoraco-abdominal aorta were allocated to DRG 108 (n=3), 110 (n=4), 111 (n=4) or 483 (tracheostomy, n=3). The mean EuroSCORE for patients with proximal aortic disease was 11 (5-18), and the length of stay was 5 days (range 3-8 days), spending 2 days (range 1-7 days) in thoracic intensive care unit. For patients with distal aortic disease the mean Euroscore was 7 (2-14), and the mean length of stay 10 days (range 4-23 days) with a mean 4 days (range 1-13 days) in intensive care unit. Eight patients developed medical problems requiring new surgical procedures or prolonged ICU stay. The average direct hospital cost for proximal aortic surgery was USD 15,877 (USD 1=NOK 7.5) while the respective 100% DRG reimbursement including one patient needing a tracheostomy, was 19 803 USD. For patients with distal aortic disease, average direct hospital cost was 23 005 USD and DRG reimbursement including patients needing a tracheostomy was 31543 USD. CONCLUSION: Our results underscore previous findings that these patients are resource intensive. This study shows that Norwegian 100% DRG reimbursement did over-compensate observed total hospital costs in this cohort. Detailed analysis showed that this was due to the higher DRG reimbursement for patients needing prolonged ventilatory support. Thus the actual DRG reimbursement seems to be relevant to the tertiary hospital actual costs when these complicated patients are considered as a group. It remains however unclear whether this reimbursement is sufficient to support the scientific infrastructure for new knowledge and skills needed for the further refinement of treatment.

Comparative costs between myocardial revascularization with or without extracorporeal circulation.

BACKGROUND: Surgical techniques of myocardial revascularization without the use of extracorporeal circulation (ECC) have raised hopes of attaining operative results with less systemic damage, lower occurrence of clinical complications and shorter hospital stay duration, generating expectations of lower hospital costs. OBJECTIVE: To evaluate the hospital costs in patients submitted to myocardial revascularization with and without ECC and in those with stable multiarterial coronary disease with preserved ventricular function. METHODS: The hospital costs were based on the existing governmental reimbursement. The costs included that of ortheses and prostheses and clinical complications. The time and costs of ICU stay and hospital stay duration were considered. RESULTS: Between January 2002 and August 2006, 131 patients were randomized to surgery with ECC (SECC), whereas 128 were randomized to surgery without ECC (WECC). The basal characteristics were similar for both groups. The costs of surgical complications were significantly lower (p < 0.001) in patients from the WECC when compared to the SECC group (606.00 +/- 525.00 vs. 945.90 +/- 440.00), as well as ICU costs: 432.20 +/- 391.70 vs. 717.70 +/- 257.70, respectively. The duration of the operating room stay were 4.9 +/- 1.1 h vs. 3.9 +/- 1.0 h, p < 0.001; at the ICU it was 48.2 +/- 17.2 h vs. 29.2 +/- 26.1h) (p < 0.001), with intubation time of 9.2 +/- 4.5 h vs. 6.4 +/- 5.1h, p < 0.001 for patients from the group with and without ECC, respectively. CONCLUSION: The present study allowed us to conclude that the myocardial revascularization surgery without extracorporeal circulation results in the decrease of operational costs and duration of the stay in each section related to the surgical treatment.

Study on mechanical circulatory support and currently available supporting parts in China.

The research and development on extracorporeal and assisted circulation in China have been painstaking. On one hand, China has the largest population of 1.3 [corrected] billion in the world, and the demands for supporting equipment are huge. On the other hand, as a developing country, China is not wealthy. It is urgent to design and fabricate affordable circulatory support parts, machines, and artificial hearts for Chinese market. In this regard, we have made our own heart-lung machine, mechanical and tissue valves, oxygenators, and artificial hearts and their improved versions. The cost of these parts is much lower as compared with those in the Western market. Although the results of clinical application are good so far, the quality of these lifesaving parts needs to be continuously improved.

Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials.

The authors undertook a meta-analysis of 37 randomized trials (3369 patients) of off-pump coronary artery bypass surgery versus conventional coronary artery bypass surgery. No significant differences were found for 30-day mortality (odds ratio [OR], 1.02; 95% confidence interval [CI], 0.58-1.80), myocardial infarction (OR, 0.77; 95%CI, 0.48-1.26), stroke (OR, 0.68; 95%CI, 0.33-1.40), renal dysfunction, intraaortic balloon pump, wound infection, rethoracotomy, or reintervention. However, off-pump coronary artery bypass surgery significantly decreased atrial fibrillation (OR, 0.58; 95%CI, 0.44-0.77), transfusion (OR, 0.43; 95%CI, 0.29-0.65), inotrope requirements (OR, 0.48; 95%CI, 0.32-0.73), respiratory infections (OR, 0.41; 95%CI, 0.23-0.74), ventilation time (weighted mean difference, -3.4 h; 95%CI, -5.1 to -1.7 h), intensive care unit stay (weighted mean difference, -0.3 days; 95%CI -0.6 to -0.1 days), and hospital stay (weighted mean difference, -1.0 days; 95%CI -1.5 to -0.5 days). Patency and neurocognitive function results were inconclusive. In-hospital and 1-yr direct costs were generally higher for conventional coronary artery bypass surgery versus off-pump coronary artery bypass surgery. Therefore, this meta-analysis demonstrates that mortality, stroke, myocardial infarction, and renal failure were not reduced in off-pump coronary artery bypass surgery surgery; however, selected short-term and mid-term clinical and resource outcomes were improved compared with conventional coronary artery bypass surgery.

Leukodepletion and aprotinin improve clinical outcome after extracorporeal circulation.

Most cardiac operations involve the use of extracorporeal circulation with its attendant systemic inflammatory response syndrome. Many anti-inflammatory strategies hold promise for reducing the associated morbidity of cardiopulmonary bypass. The application of pharmacological and mechanical strategies to control this inflammatory response now has demonstrable clinical benefit. The additional costs of these successful strategies are offset by the economic savings and improved quality of care.

Heparin-bonded circuits: clinical outcomes and costs.

The aim of this study was to use meta-analysis to combine the results of numerous studies and examine the impact of heparin-bonded circuits on clinical outcomes and the resulting costs. Heparin-bonded circuits, both ionically and covalently bonded, are examined separately. The results of the study provide evidence that heparin-bonded circuits result in improved clinical outcomes when compared to the identical nonheparin-bonded circuits. These improved clinical outcomes result in subsequent lower costs per patient with their use. However, differences are apparent in the significance and magnitude of these outcomes between ionically and covalently bonded circuits. Covalently bonded circuits provide a greater magnitude and significance of improvement in clinical outcomes than ionically bonded circuits. Total cost savings can be expected to be three times greater with covalently bonded circuits ($3231 versus $1068). It was concluded that the choice regarding the use of a heparin-bonded circuits and the type of heparin-bonded circuit used has the potential to alter clinical outcomes and subsequent costs. Cost consideration cannot be ignored, but clinical benefits should be the main rationale for the choice of cardiopulmonary bypass circuit. This analysis provides evidence that clinical benefits and cost savings can both be derived from use of the same technology-covalently bonded circuits.

Extracorporeal circulation in European Economic Community (ECC in EEC): 1979-1989.

This study determines the evolution of ECC in EEC. After recollecting the great stages of ECC since its routinely use in open heart surgery, the study situates its position in the entire world taking into account several indexes like the Gross National Product (GNP) and its evolution, the life expectancy and some other factors either technical or economical. Only a coarse analysis could be done for Europe due to an unsteady evolution. A more detailed analysis has been achieved for France thanks to a greater number of data. In such a study the major difficulty is to estimate the relevance and consistency of data which can change very quickly and are provided either by companies or by other organization.